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The Triceps Tendon Transfer (Ttt): A New Surgical Technique in the Treatment of Cubital Tunnel Syndrome
Ehsan Esmaeili, MD1; H. Kirk Watson, MD2; Lois Carlson, OTR/L, CHT2; Anselm Wong, MD2; Steven Watson, MD2
1South Florida Hand, Boca Raton, FL; 2The Hand Center - University of Connecticut, Glastonbury, CT

Purpose: Cubital tunnel syndrome is a manifestation of ulnar nerve compression at the level of the elbow. In numerous studies, a simple in-situ decompression has shown satisfactory results. Yet, in situations when a subluxing ulnar nerve complicates simple decompression, traditional approaches have recommended an anterior transposition or medial epicondylectomy. We describe a new surgical technique that includes the use of a section of the triceps tendon to address a subluxing nerve in patients with ulnar nerve neuropathy at the elbow. If the groove behind the medial epicondyle is shallow and the ulnar nerve tends to ride up on the epicondyle in full elbow flexion, the triceps tendon produces a restraint that has its effect only in significant elbow flexion.
Methods: At the completion of a standard neurolysis, the resting position of the ulnar nerve is assessed in full flexion and extension of the elbow. If the ulnar nerve tends to ride up over the epicondyle, a triceps tendon transfer (TTT) may be considered in lieu of a traditional anterior transposition. The triceps tendon is sectioned longitudinally to its insertion at the olecranon. It is then passed through a created window in the fascia of the flexor tendon origin on the tip of the medial epicondyle. Once secured, the TTT restrains the ulnar nerve in its natural groove behind the epicondyle. We have performed this procedure on 24 patients over a 5 year period.
Conclusion: The triceps tendon transfer (TTT) procedure is easy to perform as an adjunct to traditional neurolysis/decompression without the morbidity of the full anterior transposition of the ulnar nerve. Our operative results and patient satisfaction thus far have been promising, and we believe that the TTT procedure is a worthwhile option in the surgical treatment of cubital tunnel syndrome.


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